An estimated 34,360 new cases of oral and oropharyngeal cancer were diagnosed in the United States in 2007 and an estimated 7,550 people will die of the disease. More than 90% of oral and pharyngeal cancers occur in patients older than 45 years. The incidence increases steadily towards 65 years of age. Current treatment options for these patients include radiotherapy, surgery, combined radiotherapy and surgery, and chemotherapy. Treatment selection depends on size, stage and location of tumor, patient age, and comorbidities. For many patients, all treatment options are available and viable options. However, treatment is often associated with significant differences in cost. There is little known about the costs implications of treatment selection for head and neck cancer. The Broad Long-Term Objective of this research is to help physicians, specialty societies, and policymakers develop and refine treatment guidelines for patients with oral and oropharyngeal cancers. The Overall Goal of this research project is to assess the financial and clinical impact of different treatment approaches for oral and pharyngeal cancers. The Null Hypothesis is that the current treatment options are not associated with significant differences in cost or survival. There are three Specific Aims: 1. To identify factors associated with variation in treatment for oral cavity and oropharyngeal cancers in the elderly Medicare population. 2. To estimate the impact of different treatments on cost of medical care for patients with local or regional oral cavity or oropharyngeal carcinomas, controlling for demographic characteristics and comorbid conditions, and 3. To estimate the impact of treatments on overall and disease-free survival for patients with local or regional oral cavity and oropharyngeal carcinomas. This project will be a secondary data analysis of the SEER-Medicare linked database. The population will consist of patients aged 65 years of age and older who have been diagnosed with a new cancer of the oral cavity or oropharynx. Three analyses will be undertaken to study the determinants of treatment, costs, and survival associated with cancers of the oral cavity and oropharynx. This research will lead to an understanding of the factors associated with variation in medical practice, the costs of different treatments, and the clinical outcomes of different treatments. This information will inform and guide physicians as they consider treatment recommendations for individual patients, and also policy makers as they develop and refine treatment guidelines. PUBLIC HEALTH RELEVANCE: The proposed research will lead to an understanding of the factors associated with variation in treatment, the costs of different treatments, the clinical outcomes of different treatments, and relative value of alternative interventions. It will also inform and guide physicians as they consider treatment recommendations for individual patients and also policy makers as they develop and refine treatment guidelines for Medicare patients.